Individual
EDZER JEAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6445 RISING SUN AVE, PHILA, PA 19111-5228
(215) 742-3247
Mailing address
6445 RISING SUN AVE, PHILA, PA 19111-5228
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN263850
PA
Other
Enumeration date
06/10/2009
Last updated
06/10/2009
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